Clinical features

Syphilis is a complex STD with an extremely variable clinical course. Its initial stage is characterized by highly infectious open sores at the site of infection. The time between contracting the bacterium and the onset of the first symptoms can range from 10 to 90 days (average 21 days). Neurosyphilis presents 5 years or more after the initial infection. It affects 10 per cent of non-treated cases, and can take several clinical forms. (1.5)

Asymptomatic neurosyphilis

Infected subjects have abnormalities in the cerebrospinal fluid (pleocytosis, elevated protein, and reactive VDRL score), but no symptoms or signs of central nervous system disorder. It can evolve into a symptomatic form or remit on its own.

Meningovascular syphilis

This disorder usually appears within 1 to 5 years of primary infection, although it can occur as early as 6 months and as late as 12 years. (16,) In the clinical picture, the patient may develop stroke syndromes of subacute onset with a preceding encephalic picture, including psychiatric disturbances such as lability or personality changes. The patient may complain of headache, lethargy, and malaise, and may experience difficulty in concentration and exhibit faulty judgement. Emotional instability and irritability are common. Mental deterioration may progress to dementia, which can be accompanied by delusional symptomatology and episodes of excitation.(16>

General paresis

This form of parenchymal neurosyphilis is also known as dementia paralytica or general paralysis of the insane. It usually first appears some 20 years after the initial infection. Its initial symptoms are memory disturbance, dysarthria, and hyper-reflexia, which may be accompanied by personality changes and irritability—in many cases the latter are the presenting abnormalities. The symptoms progress to dementia with abnormal motor function and psychotic symptoms. These organic psychoses were frequent in the pre-penicillin era and are known for their florid clinical picture—prominent euphoric mood, expansive demeanour, and delusions of power, wealth, or social position. Other cases resemble depressive psychosis with somatic delusions.

Tabes dorsalis

This condition is a degeneration of the ascending fibres from the dorsal root ganglia, resulting in athrophy of the dorsal roots and demyelinization in the posterior columns of the cord. It can develop from 3 to 20 years after the initial infection. Main symptoms are the loss of position reflexes, ataxia, vibration sense, incontinence, and lacinating pains involving many areas of the body.

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